Peer Education: The Effects on Knowledge of Pregnancy Related Malaria and Preventive Practices in Women of Reproductive Age in Edo State, Nigeria

This study, published by the BMC Public Health journal, explored peer-to-peer education as a tool in raising knowledge of malaria in pregnancy (MIP) among women of child bearing age. According to the article, there is limited uptake of measures to prevent malaria by pregnant women in Nigeria, which often relates to lack of knowledge. In the study, 1105 women of childbearing age were interviewed in their households using a structured questionnaire about their knowledge of malaria in general, MIP, and use of preventive measures. A peer education campaign was then launched to raise the level of knowledge in the community. The interviews were repeated after the campaign and the responses between the pre- and post-intervention were compared. According to the article, the peer education campaign had a significant impact in raising the level of knowledge among the women.

The article states that several studies have suggested that both adherence to malaria treatment and uptake of malaria prevention activities are linearly associated with knowledge of the adverse health effects of malaria. Success rates of any treatment or prevention focused intervention is, thus, likely to be determined by the level of awareness of the risks of malaria and the level of knowledge on available strategies to prevent it. This suggests the need for improved education campaigns to enhance the knowledge of women about malaria and the possible preventive actions they can take. The design and key messages of such awareness campaigns are not easy to determine and depend on the local cultural background and structural possibilities. In many rural areas the possibilities of educational campaigns are limited, because of structural barriers such as poor access to professional health services and limited availability of media such as books, television, or radio. Peer education has shown to be an effective tool to improve knowledge in larger groups of people in those areas where possibilities for conventional education methods, such as radio adverts or education through health centers are limited.

In the pre-assessment before the peer education campaign, women on average answered 64.8% of the question correctly. After the campaign, the respondents answered on average 73.8% of the questions correctly. Almost all (over 90%) women had heard about malaria and the way it is transmitted. Before the intervention, 73% of the respondents knew that pregnant women were more susceptible to contracting malaria and that malaria could cause problems during pregnancy; after the intervention there was a significant increase to more than 90% of the respondents. Knowledge on preventive measures also increased significantly; while around 50% of the participants were aware that bed nets could prevent malaria before the intervention, this increased to around 80% after the intervention. Level of knowledge on use of intermittent preventive treatment (IPTp) in the prevention of malaria during pregnancy remained very low: 6% of respondents could correctly name the drug and how to use it versus 19% after the intervention.

This study found that peer education could be seen as an effective tool to increase the knowledge of young women about malaria. The use of bednets and IPTp was found to be very low in the population. Similar findings have been reported among pregnant women attending antenatal clinics in some health facilities in the state. Although this study did not specifically address the reasons why preventive measure uptake was low, this could possibly be explained by structural barriers - 97% of the respondents who said that they did not sleep under a bed net reported that they did not have one at home. A majority of the respondents mentioned that they did not have access to, for example, bed nets or did not know how to use them. Others mentioned that they did not know how to use the anti-malarial medication or that they were not available at the clinic. This shows that there may also be a need to pay extra attention to the education of health care providers and bed net distributors to enhance their knowledge and skills on bed net use, which will subsequently be transferred to the end users.

The article also mentions that although the study finds that peer education is a very effective tool to raise awareness in the community, there was limited data available to asses if there was a direct effect on the practice of women. Further studies should thus take into account a way to analyse the true uptake. In addition, true malaria incidence data would also be helpful because even if this study showed an increased effect of preventive measures in the questionnaire it does not necessarily reflect a reduction of malaria infections. A study combining these factors would thus be beneficial in order to measure the true effect of an education campaign.

In summary, the article concludes that the peer education campaign had a significant impact in raising the knowledge of women of child bearing age on malaria in pregnancy and its preventive measures. There were, however, limited data to assess whether this increased knowledge also translates in increased uptake of the preventive practices. Future studies and health interventions should thus consider other factors influencing preventive practices such as knowledge, structural barriers and lack of prevention tools (bed nets, nearby health facilities).